The Impact on Postoperative Outcomes of Intraoperative Fluid Management Strategies During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Background The impact of intraoperative fluid management during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on postoperative outcomes has been poorly investigated. This study aimed to investigate the impact of intraoperative fluid management strategy on postoperative outcomes and survival focusing on postoperative hemorrhage. Methods 509 patients undergoing CRS and HIPEC at Uppsala University Hospital/Sweden 2004-2017 were categorized into two groups according to the intraoperative fluid management strategy: pre-goal directed therapy (pre-GDT) and goal directed therapy (GDT), where a hemodynamic monitor (CardioQ or FloTrac/Vigileo) was used to optimize fluids management. Impact on morbidity, postoperative hemorrhage, length-of-stay and survival was analyzed. Results The pre-GDT group received higher intraoperative fluid volume compared to the GDT group (mean 19.9 vs. 16.2 ml/kg/h, p<0.001). Overall postoperative morbidity Grade III-V was higher in the GDT group (30% vs. 22%, p=0.03). Multivariable adjusted odds ratio (OR) for Grade III-V morbidity was 1.80 (95%CI 1.10-3.10, p=0.02) in the GDT group. Numerically, more cases of postoperative hemorrhage were found in the GDT group (9% vs. 5%, p=0.09), but no correlation was observed in the multivariable analysis 1.37 (95%CI 0.64-2.95, p=0.40). An oxaliplatin regimen was a significant risk factor for postoperative hemorrhage (p=0.03). Mean length of stay was shorter in the GDT group (17 vs. 26 days, p<0.0001). Survival did not differ between the groups. Conclusion While GDT management increased the risk for postoperative morbidity, it was associated with shortened hospital stay. Intraoperative fluid management during CRS and HIPEC did not affect the postoperative risk for hemorrhage, while the use of an oxaliplatin regimen did.